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Q: You're always criticizing the mass media's treatment of nursing. But don't you think nursing itself and society as a whole bear some responsibility for poor understanding of nursing, and for the profession's problems generally?

A: Yes, of course. We have chosen to focus our very limited resources on the mainstream media because it is our view that few others are doing that, and the disconnect between what that influential media shows and the reality of nursing is often extreme. This undervaluation is a significant factor in the nursing crisis because it inhibits recruiting and retention, and contributes to the underfunding of nursing practice, research, and education. If nursing doesn't really matter, then one nurse for 10 patients is fine, and nursing faculty don't need good salaries.

Of course the mainstream media did not all by itself create poor understanding of nursing or the nursing shortage. We are confronting a complex system in which many elements clash, merge and blend. The media affects and is affected by prevailing social attitudes and beliefs. Nursing presents itself in a certain way to the media, colleagues, political and economic actors, and the public at large. In turn, the profession is affected by how it is treated by all of those actors.

The Center believes that the mass media plays an enormous role in shaping and reinforcing social beliefs as to health care, as a great deal of public health research shows. Countless organizations focus on influencing how the media presents particular groups, ideas and subjects to the public. These include a wide range of political, commercial, and public interest actors. Although the Center may be unique in nursing, it is not unique in the world at large.

The Center has chosen to focus its efforts on the mainstream media because it perceives a great need for improvement. Much of what the media presents to the public about nursing is at extreme variance from reality. We have never said that the media is engaged in some knowing conspiracy to hurt nursing. We believe that the media, including its "elite" components, reflects many of the same biases and misunderstandings seen elsewhere in society. The key differences are that the media has a huge influence on that society, and that the media has a professional responsibility to get much closer to the truth than the average person on the street does. Finding and telling the truth about nursing (and countless other subjects, like national security) may require serious effort. But that is what the mass media is trained and well paid to provide.

Another important benefit of focusing on the media's treatment of nursing is that it provides an excellent vehicle to engage the public's interest. The popular media presents a set of common social reference points, from pop music to elite magazines, in which large and influential parts of the world public already have a deep interest. We could try to spark public interest in nursing solely through general discussions of what nurses do. But that is unlikely to generate the same level of attention as a provocative take on a Hollywood show with tens of millions of fans worldwide. People seem to care deeply if we say something about "Grey's Anatomy," Christina Aguilera, or Dr. Phil, and even if they disagree with us, we have still forced them to think about our issues. When we say that a particular show presents nurses as physician handmaidens, people already know and care about the scenario we are discussing. Needless to say, the media covers entertainment products exhaustively, and it is also intensely interested in its own workings and influence. So we are often more likely to persuade the mass media to cover nursing issues if our message relates to what the media itself is doing.

We recognize that nurses often do not present themselves to the media in an ideal way; this was the subject of Gordon and Buresh's important book From Silence to Voice. We constantly encourage nurses to speak out more often and effectively about their work. However, there is only so much we can do with current resources. Monitoring and analyzing the nursing media, for instance, would require a tremendous additional effort. We also recognize that the profession itself has many problems, such as horizontal violence, and we urge nurses to work on those. Nursing is diverse, and nurses themselves do not always agree about the nature of their profession. However, most nurses can probably agree that many media depictions are not even close. And whatever nurses' views, we hope to stimulate thought and discussion on these issues.

We also recognize that some beliefs about nurses do not flow directly from the media, but from deeply held social views that flow among family, friends, colleagues, and others. However, we do not have the resources to interact personally with every resident of the planet. What we can do is work with the mainstream media that affects what those people think.

Some appear to feel that only government regulation, such as staffing legislation, and collective bargaining agreements matter. Of course those things matter a great deal, and the Center has spent a lot of time discussing them. But they are not the only things that matter to nursing. And the specific legal framework of nursing practice is greatly affected by the media and the public views it shapes and reinforces.

We recognize that even if the public had a perfect understanding of nursing, the profession would likely still have problems. Some economic actors, for instance, would likely still resist having nursing get the rights and resources nurses feel they need. Consider the example of Gov. Schwarzenegger and the California Nurses Association in 2005.

But the fact that the mainstream media is not the only thing that matters for nursing does not mean the media does not matter at all for nursing. It simply means that nursing's problems are complex, and they will likely require a number of different strategies and activities to resolve.

In sum, we focus on the huge gap between what the media presents to the public and the reality of nursing, in the hopes that we can affect:

  1. the media's performance;
  2. the ability and willingness of nurses to analyze their public image and speak up about their work; and
  3. the understanding of the wider public.

We have never claimed that because we work to address certain problems we perceive for nursing, therefore all other efforts to address problems in nursing are pointless. By the same token, the fact that nursing may need a certain piece of legislation or a change in internal practice does not mean working to improve public understanding of the profession is pointless. All of those issues matter, and in fact, they are often closely related. Thus, we hope that those who wish to pursue issues other than those on which the Center focuses will consider that multifaceted problems often require multifaceted solutions.

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